MHA 598 Trident University Nicole Children Medical Center PPT

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MHA598 Capstone CASE 4 Trident University April 2022 Samantha Daniel Dr. Syntheia Sewell 2 Table of Contents Organization/Facility Development Health Care Organization/Facility Data Gathering & Examination Organizational Dynamics and Structure Recommendations and Conclusion Health Care Delivery, Information Systems, & Quality Assurance Health Care Delivery and Models Information Systems Quality Assurance Recommendations and Conclusion Regulatory Compliance, Health Care Law, and Ethics Regulatory Compliance and Health Care Law Health Care Ethics Recommendations and Conclusion Financial Management Community Benefit Spending Balance Sheet Statement of Operations Strategic Planning, Operational Planning, & Budgeting Recommendations and Conclusion References 3 Nicole Children’s Medical Center Introduction Nicole Children’s Medical Center (NCMC) is a nonprofit outpatient facility that provides services within Fort Worth Texas. Neurofibromatosis (NF) is the focus for type of disease management. The National Institute of Neurological disorders and Stroke (2022) states that NF consists of tumors that can involve the areas of “the brain, spinal cord, and the nerves that send signals between the brain and spinal cord and all other parts of the body” within 1% of the world’s population. NCMC offer’s services to include ophthalmologic expertise, genetic expertise and care, lab, and a family of other specialists to include daily involvement with oncology, cognitive rehabilitation, orthopedics, psychiatry/psychology, ENT, endocrinology, neurosurgery, plastic surgery, and a speech/hearing program. The target patient adolescent group is 0-17 years of age. There are several outlying conditions that can occur due to NF. NCMC provides high excellence, technical advances, and family centered care. The Mission NCMC has a mission to inspire hope by implementing outpatient screening processes for the early onset of Neurofibromatosis by providing not only the best care, but the most integrated clinical practice available. One percent of all children are diagnosed with JMML leukemia. According to the Handbook of Clinical Neurology (2015), the prevalence is “1 in 3,500 births diagnosed with NF1 and 1 in 33,000 births for NF2” each year. NCMC is only one in a handful of hospitals across the world that treats NF. NCMC commits to providing excellent patient care through the use of our individualized treatment plans. Each care plan is tailored specifically to the needs of each individual patient and their family through preventive screening. 4 The Vision The vision for NCMC is: To provide an experience that is unparalleled, so that the facility may serve as the most trusted within the NF heath care environment. NCMC meets the need of the community through working groups centered towards NF specific treatment plans. Our high quality and cost-effective treatment methods ensure that care plans will be highly effective while meeting unique patient needs. Embodied trusted care enables treatment opportunities for our patients and that allow them to enjoy the absolute best quality of life. Geographical/Size Overview NCMC is a single state and local board system that covers the small geographical area of Fort Worth Texas. NCMC is also nationally recognized as a nonprofit pediatric hospital that focuses on community population health. They organization conducts health needs assessments monthly and performs access to care outreach for populations more prone to NF. The local board within NCMC has a board of development and education that includes fundraising and philanthropy to aid in cure research efforts (Murphy, 2015). The downtown location allows for easily accessible access to care within the surrounding urban communities. NCMC has four major departments that are considered the core clinical departments. These include neurosurgery, pediatrics, orthopedics, and ophthalmology. There are 75 employees at NCMC, and each member is passionate about providing the best care possible. NCMC Data Examination City/Geographical Demographics NCMC was created in a spirit of its vision and has a responsibility to meet the requirements of the Affordable Care Act. As a not for profit organization, it assess the health 5 needs of Fort Worth by evaluating quantitative data for demographics. The Tarrant County Hospital District identified a need for NCMC’s function as it completed a six-month Community Health Needs Assessment (CHNA) for 2020 on quantitative and qualitative data within the local area. Gender and age data aid in understanding the community need for preventative services. Ages 0-14 represents 21.5% of the total service area, which drives demand for pediatric preventive services. The overall cancer rate for every 100,000 persons is 437.7, which is less favorable than the state average of 407.7 (CHNA, 2020), Bersnick, (2017). Median Population Statistics The surrounding area of NCMC in Fort Worth according to City-data (2022) online states there that the total population for 2019 was 909,585. Male presence is “442,453 (48%), the female population is 467,132 (51%)” and the area has an age range median of 32.8 years. The household medium income is $65,356. City data (2022) states the racial demographic consists of a “Hispanic population of 332,505, a black population of 168, 659, and a white population of 346,527.” Between the years 2014-2018 in Tarrant County of Fort Worth Texas, there were approximately 42,000 new cases of cancer reported. Proving 13,758 patients that died of cancer this shows the statistic of every 100,000 people within Tarrant County there were 154 patients that lost their lives (CDC, 2022). The below survey from U.S. Cancer Statistics Working Group. The below survey from U.S. Cancer Statistics Data Visualizations Tool (2021), shows data collected for the need of NCMC in Tarrant County to serve as a preventative cancer treatment center. 6 Catering to the Given Area Within 2009-2018 it was reported by the Texas Health and Human Services (2022) the most common medical conditions within the Fort Worth area are adolescent cancer leukemias, lymphoma, intracranial neoplasm, neuroblastoma, intra-spinal and retinoblastoma, malignant bone tumors, extra osseous sarcomas, and many other malignant melanomas. There are only 3 medical facilities in Texas that cater to the rare disease NF to include Children’s Medical Center Dallas, Texas Children’s Hospital, and NCMC. NCMC is the only facility that offers outpatient chemo therapy visits in order to shrink tumors caused by NF. The psychology department is set apart from the other two NF facilities due to their specialized cognitive testing that focuses on motor skills and speech. NCMC is the only facility that offers to teach parents classes on how to perform their own entry level and basic medical knowledge of home healthcare for their children. Nf Tumors may begin as benign but later develop into a malignant and life-threatening disease. Patients that are treated within the local area for NF will have access to preventative 7 services such as neurosurgery referrals, pediatrics, orthopedics, and ophthalmology. Other departments will be available to help with the expansion treatment to include a genetic counselor, social worker, a child life specialist, dermatology, plastic surgery, and adolescent psychiatry. The type and number of existing health care facilities in the area include: 21 facilities in the surrounding Fort Worth area that specialize in various types of melanoma treatments. NCMC is a facility built with compassion and a foresight just for adolescent trusted care. This facility stands out from its competitors due to its most current and top of the line early detection for NF screening process. Surrounding Cities The metroplex of the Dallas/Fort Worth area has an additional city that resides between the two called Arlington. The table below reflects the data collected for each city from city data (2022). The median household income among the three cities fall within Fort Worth ($65,356). Arlington has the lowest population of 398,854. The racial demographics between each city are close with the exception of Dallas having the highest Hispanic population. Population Fort Worth (NCMC) 909,585 Arlington Dallas 398,854 1,343,573 32 34 33 $65,356 $61,716 $55,332 Hispanic: 36% White: 38% Black: 19% Other: 7% Hispanic: 30% White: 36% Black: 23% Other: 11% Hispanic: 41% White: 29% Black: 24% Other: 6% Age Range Medium Household Income Medium Racial Demographics Organizational Dynamics and Structure Organizational Structure 8 A board cannot be effective if there is not a clear understanding of their overall responsibilities, roles, and accountabilities within the organization. NCMC operates through committees, advisory councils, and task force councils. Flexibility is key component used within the board structure due to the ever-changing healthcare demands. The functional organizational structure is a pyramid shaped hierarchy that helps define the functions within NCMC. Departmentalization encourages autonomy in order to carry out different tasker throughout the facility. Some of these tasks include… The board of directors control different departments, which allows for distinct operations monitoring and communication between all departments. NCMC’s culture is concerned with the dynamic care requirements of NF patients. The hierarchical structure consists of the board of directors, departmental levels, and the operational level. The divisional organizational structure is function-based, whereby the staff is divided within each department by their level of expertise and tasks needing to be performed. The functional level includes administrative services, business development, informational service, and financial services. Together with the medical excellence and healthcare operations departments, they are the middle level of the organization that reports to the top level of management to include the CEO and other board of directors. This structure allows for the separation of duties and ensures all areas stay focused on the mission. The organizational structure of NCMC focuses on the vision and function of the organization. The organization gives attention to its core competencies and will outsource patients to peripheral services if required. This is completed through the department of administrative services, which saves on costs and fixed expenditures through centralized operations. Fast communication is the high integration of information sharing within the 9 different structural levels. This allows for better resolution through bottlenecks confirming continuity through all oncology services. Organizational Leadership and Governance A facility’s effectiveness is based on its structural and organizational dynamics. It allows for the coordination of ideas, issues, or changes to flow seamlessly through the organization. This is so that the overall goal can be achieved within each proper level and channel of the facility and management team (Anand Narashimhan, n.d). Every level has an expectation of responsibility for its own component to follow the operation requirement needed to run a hospital. NCMC’s structure can be compared to a military structured chain of command, and within its hospital it uses the below organizational chart for their course including departmental managers, C-level executives, directors, and the governing board of directors. The leadership management process of NCMC is highly involved in all decisions that impact the organization’s mission and vision. Correct information is routed up and down the board, so that health and wellness is emphasized. Their operational structure and governance align to ensure the end goal is met, but it allows for flexibility enough to adapt to the everchanging healthcare world (Murphy, Peisert, & Murphy, 2015). The group practice manager and board of directors are in charge of all nonmedical aspects to include scheduling, employee management, and they act as a liaison for all provider needs. These areas include… Through the seven elements of governance there are essential parts within the organization that make up an excellent board. At NCMC the board recruitment focuses on training and educating within the medical excellence department and ensures their staff are 10 current on credentialing and licensure. Its board structure is made up of no more than 5 board of trustees and several subcommittees to assist with decision processes. Organizational Leadership and Governance Map Organizational Theory and Behavior Institutional Theory explains the complexity that comes from the healthcare organization (Bloom et al., 1994). The NCMC organization faces new innovations and is constantly challenged to keep up with an everchanging healthcare environment. To battle these issues, NCMC ensures that they are equipped with the most up to date equipment and training for their staff and facility. NF is the focus of treatment within the community, and in order to stand above all others, they have created a unique cultural competence within the facility. Its care equity removes barriers that are non-compliant with patients’ needs. NCMC demands inclusion among 11 its providers, so that behaviors and social norms of the organization best treat all patients. All genders, race, and socioeconomic statuses are welcome within the facility. Cultural competence is what strengthens NCMC, and allows for patient families to really connect with their services. It can improve the experience and outcome of treatment for patients (Lakshmi, 2019). A key concern within healthcare is change and instability within processes. NCMC is obligated to acquire and maintain the expertise needed to take on these professional tasks with change. Their systemic approach allows them to develop the tools and training to rise above their competition. This approach allows for strategy adoption, information technology, configurations, and other conditions that occur within the environment (SHRM 2021). The electronic health record can expedite labs, radiology, pharmacy, provider information to the patient for education purposes, and allows easier continuity of care for hospitals outside of NCMC. Dynamics of NCMC NCMC target subjects for their market include an adolescent age group ranging from 017 with all races to include Hispanic, black, Asian, and white communities. The Dallas, Fort Worth, and Arlington metroplex are all areas from where the facility will receive primarily receive patients, however, this does not exclude patients coming from elsewhere in the world. Culturally sensitive care is crucial to meet the needs of all patients. Betancourt, Green, and Carrillo (2002) explain cultural competence is the ability for organizations to effectively deliver healthcare that meet the social, cultural and linguistic needs of patients. An example, the ability to unify and bridge certain language barriers can help accommodate diverse patients, while paying attention to their understanding of the illness and treatment plan. This can include western medicine along with their own cultural needs. An 12 extension of patient centered care includes cultural competence, and it sets the tone for the provider and the patient. NCMC can assure that their healthcare providers understand the evolving concept and are able to provide culturally competent care to improve the overall quality and effectiveness of treatment while reducing disparities (Henderson, Horne, Hills, & Kendall, 2018). Once a patient enters the facility, they are then greeted by the patient check in center and triaged for the correct appointment area. The patient work flow of NCMC identifies the priority of care needed. If a patient needs outpatient care facilities such as pediatrics, orthopedics, ophthalmology, genetic counselor, mental health, or dermatology they will be sent to their perspective departments for treatment. Other more invasive services such as neurosurgery or plastic surgery will require a referral from a NCMC provider to a local hospital nearby. Mandatory training programs for all employees covering inclusion and respect within the healthcare environment (to include board members) are mandatory. The training addresses all areas to include: respect and acceptance, religious accommodations, cultural differences, generational gaps, and language barriers. The Texas Diversity Counsel offers courses such as the Diversity First Certification program, toolkit, and consulting to ensure the NCMC team is well prepared for the dynamics that are faced in this region (txdc.org, 2022). Recommendations and Conclusion Healthcare is constantly changing, and NCMC is able to deliver a promise to its patient population that they will be the top organization with trusted care and new patient treatment advances for NF patients. It is recommended that NCMC remains involved with new developments concerning medical treatment advances. The top-of-the-line electronic systems NCMC can power through delivery of care at an advanced more quality level of care. NF may 13 not have a cure now, but with the correct organizational leadership and delivery of care, anything is possible in the future. CASE 2: Healthcare Delivery and Models Accountable Care Organization/Comprehensive Services NCMC as a non-profit organization will fall under an Accountable Care Organization (ACO). This children’s facility is driven to help all patients in the preventative care treatment of NF without profiting from their services (Colla, Lewis, 2016). Because NCMC is an ACO they do not require their patients to have a PCM. Theycan be seen directly at their facility without a referral. Providers work as a team, so that they do not unnecessarily repeat tests, and that the best quality of care is provided to the consumer. Continuity of care is the focus and is in the best interest of the consumer, so the best possible outcome will be obtained. The overall cost of medical care can be reduced by avoiding repeat tests or errors in treatment plans. The network at NCMC includes their oncology providers, cognitive rehabilitation specialist, orthopedic providers, psychiatrist, ENT, endocrinology, neurosurgeon, plastic surgeon, nurses, and technician support. Delivery of Care Map 14 Engaging Health E-health is a strategy used by NCMC to engage patients and allow for continuity of care to further treatment possibilities. With the rise of Covid-19 and dealing with patients that have lower immunity, engagement health is imperative in keeping their patients safe. NCMC offers telehealth by allowing Facetime appointments for those that are not needing labs or any physical type of care. Facetime telehealth care helps provide better facilitated home care. The patient portal allows access for consumers to view a provider directory when needing to call or schedule future appointments (Bauer, 2018). Education materials about NF and other cancers is available via the patient portal. NCMC allows for online and mobile tools so that consumers can communicate the dimensions of their immediate issues for follow on care. Mobile tracking allows for the monitoring of medication side effect treatments and can allow the physician to make adjustments right away instead of the patient having to wait for the next available in person appointment. Oncologists can collect the data received from the telehealth appointments and review information collected in advance of the next appointment, so no time is wasted. Redundancies are eliminated through the electronic health record (EHR) via data collection. The overall goal for e-health is to improve patient engagement, outcomes, reduce emergency rates, can lower cost of care, improve medication management, and patient satisfaction (Bauer, 2018). Information Systems The EHR is used to enable continuity of care and allows for a better treatment plan and outcome. USA.gov (2019) uses a national survey to identify that 94% of information used within an EHR is readily available. Evidence shows that 88% of providers prefer the EHR over a hard 15 copy record, due to the clinical benefits for their patients, and 75% of providers believe the delivery of care is expedited. Medhost EHR allows for patient data to be stored electronically in one folder, allows for an automated prescription process, and can provide education for patients. The patient’s information will be secured electronically and aids in the delivery of care. This system allows data to be stored accurately. Medhost allows information to be transferred to lateral healthcare agencies for smoother transitions of careand allows for the most up to date economical software, while allowing the required output for the provider (Roboam, 2019). Medhost also allows for computerized provider order entry (CPOE), patient portal, clinical decision support system (CDSS), and evolving patient education options (Karimia, 2015). Standards applied consist of data interchange, terminologies, and knowledge representation. Medhost has security measures in place that identify errors such as wrong patient identifiers, incorrect prescription doses, patient information is secured and never lost, and it allows for the automatic implementation of all Health Insurance Portability and Accountability Act of 1996 (HIPAA) laws. According to the centers for Disease Control and Prevention (2022), they state HIPAA is a federally regulated law that stands as a national standard for protecting sensitive patient information, so that it is not disclosed without consent from the patient. HIPAA is implemented through the EHR system and ensures the confidentiality of all electronic information. The Medhost system does not allow impermissible use and will flag the organization with these regulations are violated. NCMC regularly tests the backup systems to ensure that information is stored correctly. Passwords are enforced by each user, and the server is designated as a secure room with only special entry authorized for staff. Message format standards facilitate the system in order to exchange patient information within the facility. This allows for 16 comprehension within interconnection of data components (Borrks,, Avera, 2010). In case of system failure there could be a paper medical record developed temporarily until the electronic systems are back online. Once restored the paper copy would then be transcribed into the EHR. Operations Management Organizational Process and their Map’s Access to care can be a major issue that deals with persistent inefficiencies that are mainly caused by communication issues. This can quickly turn into healthcare safety and quality issues when patients continue to reach major gaps in their appointment booking process. Poor care coordination will lead to a patient’s critical concern not reaching the provider. Information such as adverse drug interactions, treatment plan issues, or lapses in treatment may require a patient to be seen in person. The Joint Commission reported from 2014-2015 patient communication failure was the leading cause of 197 sentinel events (Clarke, Bourn, Skoufalos, Beck, & Castillo, 2017). 17 NCMC is divided into different departments to ensure the mission is completed. The quality of service relies on the delivery within each department. Each department specializes in oncology specifically, but allows for different levels of care depending on the needs of the treatment plan. NCMC ensures that with every phone call missed the patient is contacted within a 48-hour turnaround time to prevent sentential events from occurring. Once the patient is seen within the facility, wait times can be an issue with a patient’s satisfaction with their care experience. NCMC has created a call ahead phone service that allows for patients to check if there is a long wait time and provide them the option to reschedule. Patients can also login using their cell phones through a patient portal check in to fill out any paperwork ahead of their appointment. Below is a map to show the wait time product. Operational Excellence Scale & Tools NCMC has significant operational components of excellence that allow a means for the organization to include work teams, operations and process excellence and performance management. Performance management is a critical tool used in training and should be 18 completed by not only training guides, but through on-the-job training (Mclaughlin & Olson, 2017). Six Sigma training is provided for productivity gains to include revision of policies and procedures if a current process is hindering the system from seamlessly operating. Failed processes can lead to revenue loss and detrimental sentinel events, Six Sigma allows for the recognition of failed processes, and a way to a means of retraining of leadership staff, employees, and departments. Efficient patient movement in healthcare facilities can significantly improve the quality-of-care patients receive and substantially improve financial performance (Mclaughlin & Olson, 2017). NCMC applies the Six Sigma methodology at their facility when problems arise; the problem defined, validate measurement of the problem, analyze what the root cause of the problem is, find a solution to improve the problem, and control the problem by developing a plan. When employees find a process that hinders the workflow, they define the issue and give thorough examples of how the current failing process is hindering the current workflow. As a team the employees define the issue, then offer cost effect, safe solutions to the problem, they measure how the process has improved over a set amount of time. Continuous process improvement is essential for organizations to meet the challenges of today’s healthcare environment (Mclaughlin & Olson, 2017). This is best accomplished by a committee comprised of all levels of staff members, department and facility wide. Teamwork is an important principle used to maintain superb performance and increase patient satisfaction. The merging of Six Sigma and Lean can allow the two methods to complement each other by improving several compliance programs. Lean focuses on eliminating waste and allows for processes to be streamlined. An example may be to eliminate time used to locate unnecessary equipment and the use of idle time when items are lost. While Six Sigma brings training value to 19 the overall patient care, the Lean process allows for the equipment to be in the area needed to not waste time, allowing for proper training, and ultimately helps prevent sentinel events. Quality Assurance and Accreditation Six Domains of Healthcare Quality The Agency for Healthcare and Research and Quality (n.d) speak to frameworks for quality assessment’s that have measures that are developed to create initiatives through private and public sectors. NCMC follows the six domains of healthcare quality to ensure the best quantity of care is provided to their patients. Patients are asked several times throughout their visits for their patient identifiers to ensure they are there for the correct treatment. This helps provide a safer environment. Providers are not paid per service since NCMC is a nonprofit facility there is no pressure for unethical or illegal misuse of service. Organization ethics within NCMC allow for patient centered care in that all staff are expected to treat their patients with the upmost dignity and respect. Patient centered care is completed through principles such as a uniform standard of care throughout the facility. In order to reduce wait times, nurses ensure that patient receive a call or text with wait time information. Patients are provided the ability to reschedule or utilize telehealth appointments. Appointments are triaged to ensure those that needing to be seen in person are brought in at their earliest convenience. NCMC ensures efficiency by utilizing the most current information systems to secure a point of service by enabling providers to see all previous medical appointments prior to the patient’s current visit. This avoids misplacement of documents and boosts productivity. Due to NCMC’s code of ethics, they do not judge patients on their ethnicity, gender, geographic 20 location, or socioeconomic status (AHRQ, n.d). Culturally competent care is provided by a diversified staff to ensure trust and inclusion are equitable. Conclusion and Recommendations Healthcare delivery models for NCMC help build a snapshot of processes that use improvement within identified areas. This helps the overall organization better utilize their time for patient care by advancing the best quality of care. Information systems are a part of continuity of care and allow for a better transfer of patient information. It is recommended that NCMC attends quarterly training to stay current with compliance standards and continue to utilize the training to better patient care. Case 3: Regulatory Compliance, Healthcare Law, & Ethics Regulatory Compliance & Healthcare Law Executive Summary-Federal, State, and Local Laws NCMC ensures that all staff conducts themselves in an ethical manor with an emphasis on its shared values that will guide all actions they may be questionable within the workplace. These standards are periodically reviewed then enhancements are created when deemed necessary by the board of directors. These standards are introduced during orientation for all employees. Establishing a corporate compliance program within NCMC ensures the safety and quality of its patients. Proper planning will allow for the organization to manage programs through government laws and incentives. NCMC utilizes the Patient Safety Quality Improvement rule and the Patient Safety Act in order to follow government guidelines. Patient Safety and Quality Improvement rule allows for the organization to improve services and reduce high risk safety issues. NCMC will collect confidential information from patients about their appointment 21 experience and their safety within the visit. The patient safety rule allows for patient safety violations to be frequently reported to help manage safety events (Agency for Healthcare Research and Quality, 2020). NCMC will have an open-door policy for reporting unethical behavior within the organization. The Texas Medical Privacy Act is a more in-depth state law that gives more privacy protection then under the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPPA. The state law fills in the gaps that the federal law does not apply. The Texas law has a broader range of regulations, it does not allow patient information to be used for marketing, and does not allow the re-identification of information of which had already been un-identified (ASPE, 2001). NCMC does not use a patients private health information for its marketing strategy without containing consent from its patients. The policy in place for marketing is that the patients will advise the providers of the impact they would want their child’s health information to give. Providers will not approach the families nor proceed with consent without utilizing proper consent forms through the administrative office. NCMC opposes any policy pertaining to injectable drugs outside of their practice. Significant risks can occur when outside drugs are involved within the treatment of a patients care. The liability poses a risk to the integrity of the product, labeling, and to the condition of the patient of which the drug may be exposing. The treatment therapies will never be a “self-service” environment and the policy were developed to protect the mission and vision of the facility by ensuring the proper delivery of the best and most trusted care. Corporate Compliance Program Infrastructure The designation of the Chief Compliance Officer reports directly to the Chief Executive Officer and the continuing governing board of directors. This also combines the efforts of the 22 managers that control the operation of each program through active participation of the compliance committee. They are all charged with the role of overseeing the laws and regulations of the facility to ensure that compliance is properly coordinated. Education, Training, & Safety Regular training of all staff members will be implemented to include administrators, providers, and nurses on how to maintain patient confidentiality. HIPPA training is required annually and through online refresher courses for members that are required. Regular employee training will be required within each members duties to maintain their expectation and job performance. This will be a hassle-free process that can be creative and fun throughout the facility each month. Proper patient confidentiality should be maintained through all electronic devices. This includes restriction of mobile devices within patient areas. This is to prevent accidental or malicious attempts to violate sensitive information with photos or recording conversations. Policies against personal devices exclude all private lap tops and tablets for protection of patient information. The amount of patient data stored is now astronomical due to the influx in population and quality of care. NCMC utilizes biometric patient identification to maintain patient confidentiality and uphold patient security. This product prevents the duplication of patient files and has encryption features. This cloud-based system can recognize patients by using their photo (Sohn, Kim, Park, Lee, Monroe, Malone, Kinsella, Yao, Kunos, Lo, Shenk, & Machtay, 2020). Two Way Communication in All levels Effective communication at NCMC is an essential part of the mission due to the flow of patient care. These tools can be a great way to explore non-compliance within the facility and 23 allow for change. The leaders and staff ensure that they are seen each day by being visible and approachable not only to staff, but patients as well to adhere directly to any concerns. The organization encourages open communication with no punitive actions or retaliation for members coming forward with issues (Womble & Dickinson, 2020). All compliance measures are briefed during weekly meetings to include a daily safety huddle led by the board of directors and the team leads of all departments. Patents are given anonymous hot line numbers in order to provide feedback about their appointments (Lovitky, 1999). Quarterly the staff are given a survey system to voice their concerns about compliance violations or leadership issues. Monitoring System to Measure Effectiveness Internal monitoring and auditing are completed daily within the information system area of NCMC. An annual work plan is developed to address areas of concern to include analyzing areas of concern from the previous years audit. This allows for the tracking of trend, benchmark, and identify and outliers. Areas of risk are traced contracts, billing, coding, and quality of care (Womble & Dickinson, 2020). Audits are completed proactively to meet the goals set for NCMC and ensure that the compliance programs are being met. Enforce Discipline & Corrective Action Plan Standard violations within NCMC are thoroughly enforced with their well published disciplinary guidance. Appropriate actions will take place the moment a violation occurs so that the process can be corrected immediately. Errors are sought out and the individual or area within the organization is identified. NCMC allows for a “just culture” that balances the need for honest reporting and a responsibility to hold employees accountable if their behavioral choices prove to be malicious. This culture requires change from errors reported and the ability to design a system to overcome all obstacles. Below is an algorithm created for the 24 outcome of engineering principles that analyze risks according to Frankel and Leonard (010): Healthcare Ethics Code of Ethics In order to determine appropriate behavior within the staff of NCMC, a code of ethics has been developed to promote dignity and well-being associated with the hospital. NCMC leads by example by creating a valuable work environment and ensures that unethical behavior will have zero tolerance. NCMC board of executives abide by the same codes as all other employees. They have been charged to follow up on all unethical behavior and encourage respect and trust within the facility. Trust is what allows for maximum service and ultimate success. The development of NCMC’s ethics plan ensures autonomy for all patients and applies to all areas to include autonomy, justice, respect, efficiency, proportionality, and for goodwill (ACHE, 2020). Healthcare ethics provide better avenues when making decisions for treatment plans and prescribing medications. Autonomy enables a patient to keep their honor by allowing the patient or guardian to choose for their family how they would like to proceed with a treatment plan (ACHE, 2020). Beneficence ensures the correct treatment is provided through a checks and balances system. For example, before providing further care 25 the check in desk asks for full patient demographics and then are asked again by the provider once they enter the facility. Justice is what allows for fair treatment no matter the race or color which is why NCMC has a staff with different ethnicities and cultures. An example of the use of code of ethics is ensuring patient privacy is restricted to a “need to know” only basis. Unauthorized members should not have access to information if they are not directly involved in the patients care. The ethical practice has legal implications that effect HIPPA guidelines (ACHE, 2020). Integrity and honesty in a treatment plan is important so that the patient’s family can be fully prepared for what they will face throughout a disease such as NF. This can prevent interruption of care create a strong treatment plan in the beginning of the process. Healthcare Ethical Committee-Identify the Members The members on the healthcare ethical committee for NCMC help resolve difficult issues that could inherently affect the treatment of patients care. The committee studies the issue and decide as a team to take action or further discuss options. Confidence is promoted within the organization due to the combining power of knowledge of the team. Their team includes physicians, nurses from each area, mental health providers, community representatives, and administrators. The chairman is a provider that leads the committee and was chosen by the hospital through a voter polling system. The provider was chosen has they were the most reliable person to listen to all sides of the situation without judgement and can contribute to the medical aspect of the ethical decision. This provider is not actively involved in patient care thus allowing time to respond to issues. There is an assistant to the chairperson which is a hospital administrator that helps with the policy and regulations that are ethically required. 26 The committee has a secretary to record minutes for each meeting which ensure the continuity of care on all of the organization’s ethical issues. A lawyer will be present to determine the federal and state law regulations that can be violated through HIPPA and avoid penalties from the government. A pediatric oncology specialist will be apart of the decision process on treatment plans and ethical behavior. Distinguished Roles & Responsibilities The role of an ethical committee is to create solutions to ethical treatment decisions before a mistake is made. They are also involved when mistakes are made and can be an advisor to staff to maintain the quality of service (Schonfeld & Hester, 2012). The committee serves as an investigation process to ensure the staff maintain efficient access to all services in order to make prominent decision-making diagnosis. Stakeholders are not required to take the advice of a committee board, but there is a requirement of reasoning on why the advice would be denied. NCMC has an ethical set of bylaws that define the structure of the team. The committee is multidisciplinary in that the professionals serving have a variety of expertise. They are charged to be objective in the outcome of the action and be within the best interest of the patient. The administrator can offer legitimacy and encourage better use of resources. All members believe in the importance for the committee and devote much of their time to solving issues (Sconfeld & Hester, 2012). All perspectives on the team are well respected amongst each other which ultimately creates a professional environment to talk about all ethical issues. Conclusions and Recommendations The healthcare ethical committee is a key factor within LCMC that allows for better decision-making processes within complex treatment cases. This team is adapted within the 27 structure to benefit the mission and size of the facility. Tracking will promote a clearer picture of policies and guidelines that are needed for appropriate care. Recommendations include ensuring the ethical committee team is revied annually in case changes of members are needed. All staff should be informed of a zero-tolerance policy on unethical behavior. Case 4: Financial Management This report will demonstrate how the Nicole Children’s Medical Center will handle its finances in helping the community. It will also illustrate the organization's spending by using a balance sheet for the current and subsequent year, with a statement of operation for this organization. Strategic planning, budgeting, and operational planning are an important part of an organization because it helps identify suitable operations to align with the company's finances and goals. Community benefit Spending NCMC will spend its budget by providing preventative measures and treatment options for people in the community diagnosed with Neurofibromatosis. The organization will spend money preparing and providing the best clinical practices for this medical condition affecting people through this operation. It will also offer a diagnosis platform for every person to help them identify whether they are suffering from Neurofibromatosis (Chaiyachati & Werner, 2018). With this platform in place, it will be easy for the community to access free screenings, clinics, and other self-help programs within NCMC. It will also invest in research about this medical condition in Texas to identify its prevalence in this area (Fugate, 2018). The research should help identify where NCMC can start when dealing with the condition. It will also help identify where more efforts need to be put to prevent further cases of the conditions and how the community can support the sick to help them get better easily. 28 NCMC will also use the funds to create awareness in Texas about Neurofibromatosis, helping the large population know about the disease and get a better idea of how they can manage the condition with medical assistance from the hospital's medical professionals. There can also be an initiation of healthcare programs that will help the community; for example, the implementation of health practices the community should consider for their children and teenagers, and other highly affected people (Fugate, 2018). It should help the community get excellent medical care even if they cannot handle all the medical expenses required to treat thee medical condition (Singh et al., 2018). Therefore, the community will not be expected to make any payments when using healthcare services from this medical facility. They will also be expected to get all their medical needs. The community should also expect that from NCMC, they will get quality medical care for the Neurofibromatosis condition at any time and even during medical emergencies. Balance Sheet This balance sheet will show NCMC's financial position this year and next year by presenting its assets, liabilities, and net assets to see how the organization will use them. ASSETS Current Assets Cash Temporary investments Receivables Inventory Prepaid expenses Total Current Assets Non-current assets Land, plant, equipment Accumulated depreciation Long-term investments Other non-current assets Total non-current assets Total assets 2023 2022 $23,874 3850 125,675 1205 503 $155,107 $42,300 3600 187,300 1058 600 $234,858 22,345 -9820 18,300 1250 18,800 1,773,907 21,050 -8970 16000 1405 19,705 2,545,630 29 LIABILITIES AND NET ASSETS Current liabilities Accounts payable Notes payable Accrued expenses payable Deferred revenues Estimated third-party adjustments Current portion of long-term debt Total current liabilities Non-current liabilities Total liabilities NET ASSETS Unrestricted net assets Temporary net assets Permanent net assets Total net assets Total liabilities and net assets $154800 2340 202450 300 12300 2340 17935 10,879 532,940 $180960 2300 154560 400 18600 2280 20392 10500 508,920 623890 477,765 12082 153,590 $1,240,967 846010 370,800 13700 176,000 $2,036,710 The assets are the valuables in the company that NCMC will benefit from for their personal use in helping the community. Assets include cash, temporary investments, inventories, and other assets that could benefit the company. Cash, in this case, is the amount of money NCMC can access, whether from the bank or at hand (Norwicki, 2018). The organization could put some investments with maturity for some time, for example, one or two years. These funds are temporary investments and are expected to help the company in the coming future after their maturity. Inventories include the costs of needs the company's stakeholders will require, for example, fuel, food, water, drugs, and other supplies necessary for the company to succeed in its mission in the community (Norwicki, 2018). These supplies are mostly not yet used but have already been purchased by the organization. Non-current assets are the resources NCMC will expect to consume over one year yet have a life span of one year. NCMC has long-term investments, which it will expect to help it in the future of its operations. For example, the organization could have corporate bonds and government securities that will help it in future expenses required to help the community, especially when the company's funds are running low. 30 These investments will act as security for NCMC, helping the organization's operations complete successfully, especially in the coming future. When it comes to liabilities, NCMC has a financial obligation or debt that can help its operations. For example, current liabilities will help the organization within its every year. Estimated third-party adjustments are the amount of money NCMC will need to return to its investors, especially from any overpayment to the organization (Norwicki, 2018). Long-term liabilities include the obligations NCMC has, such as debts that have been due for more than one year. Net assets differ between assets and liabilities, representing the company's financial interests. Under these assets, it is important to understand the difference between restricted and unrestricted net assets. Unrestricted net assets are the net assets NCMC has not restricted externally by donors and grantors. NCMC will restrict their assets that do not have an expiry for permanently restricted assets. They include the restricted assets for donors and endowment funds, but in most cases, they operate without the donors’ restrictions or can be both (Norwicki, 2018). The nature of net assets requires NCMC to disclose the number of donor restrictions and their nature. This balance sheet shows all operations in NCMC and how they will affect the company. Additionally, they act as securities for the organization, especially when dealing with donors and bank loans, showing the expected effects on all leases on the sheet. Therefore, Assets= liabilities + net assets Statement of Operations This statement of operations will demonstrate NCMC's net revenues, expenses, and overpaid net revenues over this year and the subsequent year. It will demonstrate a relationship with the balance sheet. The permanent accounts in the balance sheet are the accounts carrying the balances the company will forward to the subsequent year. 31 REVENUE Gross patient services revenue Provision for contractual adjustments Provisions for charity are Net Patient service revenue Provision for bad debt allowance Net patient services revenue fewer provisions for bad debt Premium revenue Other operating revenue Total operating revenue EXPENSES Salaries, wages, and benefits Supplies, drugs, and purchased services Depreciation and amortization Interest Total operating expenses OPERATING INCOME NON-OPERATING INCOME Investment income EXCESS OF REVENUE OVER EXPENSES Unrestricted net assets Temporary restricted net assets Permanently restricted assets CHANGE IN NET ASSETS Total changes in net assets 2023 2022 $230,980 -33,509 -1234 196,237 -2050 194,187 $200,490 -28905 -1050 170,950 -13800 157,150 2500 2800 199,487 0 2850 160,000 89,786 79,230 2345 1090 172,451 -300 92,300 75,300 2205 1002 170,807 -4320 $800 789 23,409 5065 2050 $750 -4200 28903 5000 4090 30,524 37,993 Net patient services revenue is the money NCMC will generate through their operations, except the money will collect from patients due to charity care. NCMC will not expect any patient service revenue because its characteristic of being a non-profit organization does not expect any cash flow from its patients' services. Another operating revenue NCMC generates the office space, rental equipment, and sales supplies of all medicines and equipment it needs (Norwicki, 2018). The operations of NCMC are not taxed by the government, except other unrelated business expenses like gift shops are taxed, which differentiates the operating and nonoperating revenue of the company. 32 Operating margin= operating income x 100 Total operating revenue = -4320 x100 = -2.5% 170,807 The companies operating margin is -2.5% because the NCMC is a not-for-profit organization, meaning that it will incur negative profits. The company is not expected to make any profits because its main aim is to help the community without expecting any profits. Therefore, NCMC will expect additional funding to remain in operation. Strategic Planning, Operational Planning, & Budgeting Strategic Planning The first step in strategic planning is validating mission and strategic interpretations. NCMC uses strategic interpretations to organize purposes through a mission and vision statement. By assessing its external environment, NCMC can identify the best environment to conduct its charity operations, especially where more people have special needs. The environment should also provide a chance for expansion (Norwicki, 2018). NCMC’s internal environment should provide a better direction for the company. It can better manage its resources and have better leadership to use all opportunities and strengths for the community's benefit (de Paula Rodríguez Perera & Peiró, 2012). NCMC has a vision that has helped through its internal and external operations. It communicates its vision through its operations, and this has effectively. NCMC needs to establish a strategic thrust to achieve more on its goals and help the Texas community such that it can relate its goal to its vision and mission. When it comes to identifying essential success factors, NCMC must learn the strategies that will help it avoid more debt and loans, but it should still be able to manage the community services and pay for all 33 expenses. NCMC has properly organized and developed primary and core objectives for the community benefits. When it comes to financial planning, NCMC should work better to ensure they can manage the funds they get better. Operational Planning NCMC should organize meaningful employee participation in all community service operations to achieve all objectives. Policies are very important, which NCMC has developed. Such policies include code of ethics and conflict of interest policies. There are procedures important for NCMC that can help plan all corporate processes and achieve them successfully (Norwicki, 2018). All procedures must be clear to all managers and supervisors to ensure they achieve the specific actions from the policies. NCMC's management needs to develop methods for strategic planning that will help accomplish the procedures. These methods should be specific and realistic. NCMC needs to develop strict rules at this time to ensure that all employees follow them strictly. Budgeting Budgeting is an important part for the company to focus on by projecting volumes for the budget years. The budget committee will ensure that all other factors do not influence the budget. The managers will then convert the volumes to revenues by identifying whether the budget should be made after the expense budget is completed (Norwicki, 2018). The organization will then convert volumes into expense requirements by using them to make orders of supplies and pay all expenses. The last step the company will make is to adjust all revenues according to their planning processes to see whether they need to reduce or increase the budget. Conclusions and Recommendations 34 It is important for NCMC managers to carefully look through all company processes and see how to organize the processes and ensure they match the community's needs. It is also important for the company to properly manage all resources to prevent overspending and more debts. It can be concluded that NCMC will spend its money helping the community by providing treatment options for people in the community suffering from Neurofibromatosis. 35 References Agency for Healthcare Research and Quality. (n.d.). Six domains of health care quality. Retrieved from https://www.ahrq.gov/talkingquality/measures/six-domains.html American College of Healthcare Executives. (2020). ACHE code of ethics. Retrieved from https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics Anand Narasimhan, H. H. (n.d.). Organizational design: Inviting the outside in. Retrieved from IMD Corporate Learning Network: https://www.imd.org/researchknowledge/articles/organizational-design-inviting-the-outside-in/ Bauer, G. (2018). Delivering value-based care with e-health services. ACHE. Retrieved from https://www.ache.org/-/media/ache/aboutache/covid/hap/deliveringvaluebasedcarewithehealthservices5.pdf Bersnick, J., (2017). Which Healthcare Data is Important for Population Health Management? Retrieved from https://healthitanalytics.com/news/which-healthcare-data-is-importantfor-population-health-management Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2002). Cultural competence in health care: Emerging frameworks and practical approaches. New York, NY: The Commonwealth Fund. https://hpi.georgetown.edu/agingsociety/pubhtml/cultural/cultural.html Bloom, J. R., Alexander, J. A., Lerman, S., & Norrish, B. (1994). Institutional and environmental influences on staffing strategies. Dallas, TX: Academy of Management. Brooks, P., & Avera, H. (2010). Standards and interoperability in healthcare information systems: Current status, problems, and research issues. In Fifth MWAIS Conference. 36 City-data.com. (2022). Welcome to City-data. Retrieved from http://www.city-data.com/ Chaiyachati, K. H., Qi, M., & Werner, R. M. (2018). Non-profit hospital community benefits spending based on local sociodemographics. Journal of Health Care for the Poor and Underserved, 29(4), 1259-1268. Retrieved from the Trident Online Library. Clarke, J., Bourn, S., Skoufalos, A., Beck, E.H., & Castillo, D.J. (2017). An innovative approach to health care delivery for patients with chronic conditions. Population Health Management, 20(1):23–30. doi:10.1089/pop.2016.0076. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278805/#__ffn_sectitle Colla, C. H., & Lewis, V. (2016). Hospitals Participating in Accountable Care Organizations Tend to Be Large and Urban, Allowing Access to Capital and Data. Improving Health Care Quality. De Paula Rodríguez Perera, F., & Peiró, M. (2012). Strategic planning in healthcare organizations. Revista Española de Cardiología, 65(8), 749-754. doi: 10.1016/j.rec.2012.04.004. Retrieved from the Trident Online Library. Fugate, T. (2018). What is community benefit spending, and why does it matter for not-for-profit hospitals? Minnesota Nurses Association. Retrieved from https://mnnurses.org/what-iscommunity-benefit-spending-and-why-does-it-matter-for-not-for-profit-hospitals/ Glandon, G. L., Smaltz, D., & Slovensky, D. (2013). Information Systems for Healthcare Management (8 ed.). Americal College of Healthcare Executives. 37 Frankel A., Leonard MW., (2010). The path to safe and reliable healthcare. Patient Educ Couns. Sep;80(3):288–292. Epub 2010 Aug 4. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20688455/ Health Network Community Health Needs Assessment. (2020). Tarrant County Hospital District/JPS. Retrieved from https://safe.menlosecurity.com/doc/docview/viewer/docN67A799D84BBDe00ba0926bd9 3e08f4b428d998d5f6b4155eab3efa049fd4771f296f6807147d Handbook of Clinical Neurology. (2015). Chapter 4 - Neurofibromatosis type 1 and Chapter 5 Neurofibromatosis type 2. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/B9780444627025000044 Karimia, F. (2015). Clinical information systems end-user satisfaction: The expectations and needs congruencies effects. Journal of Biomedical Informatics, 53:342–354. Retrieved from: http://www.sciencedirect.com/science/article/pii/S1532046414002731 Lakshmi, N., Adetayo, A., (2019) Cultural Competence and Ethnic Diversity in Healthcare. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571328/ Lovitky, J.A. & Ahern, J. (1999) Designing compliance programs that foster ethical behavior. Healthcare Financial Management, 53(3) 38, 40-42. McLaughlin, D. B., & Olson, J. R. (2017). Chapter 15: Holding gains. Healthcare Operations Management. Chicago: Health Administration Press. Murphy, S. P., Peisert, K. C., & Murphy, C. J. (2015). Board organization and structure. The Governance Institute. Retrieved from https://nrchealth.com/wp- 38 content/uploads/2017/05/Board-Organization-Structure_An-Intentional-GovernanceGuide_Patrick-M....pdf National Institute of Neurological Disorders and Stroke. (2022). Neurofibromatosis Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/FactSheets/Neurofibromatosis-Fact-Sheet Nowicki, M. (2018). Chapter 3: Financial analysis and management reporting. An Introduction to the financial management of health organizations (7th ed.) Chicago, IL: Health Administration Press. Available in the Trident Online Library via the Skillsoft database link. Nowicki, M. (2018). Chapter 13: Strategic and operational planning. An Introduction to the financial management of health organizations (7th ed.) Chicago, IL: Health Administration Press. Available in the Trident Online Library via the Skillsoft database link. Nowicki, M. (2018). Chapter 14: Budgeting. An Introduction to the financial management of health organizations (7th ed.) Chicago, IL: Health Administration Press. Available in the Trident Online Library via the Skillsoft database link. Nowicki, M. (2018). Chapter 15: Capital budgeting. An Introduction to the financial management of health organizations (7th ed.) Chicago, IL: Health Administration Press. Available in the Trident Online Library via the Skillsoft database link. Roboam, A. R., Orlando, S., Marcos, F., & Sanchez, G. M. (2019). Electronic Health Record implementation: A review of resources and tools. Cureus, 11(9). Retrieved from https://www.cureus.com/articles/21899-electronic-health-record-implementation-areview-of-resources-and-tools 39 Schonfeld, T., & Hester, M. (2012). Introduction to healthcare ethics committees. In Guidance for healthcare ethics committees. United Kingdom. United Kingdom: Cambridge University Press. Singh, S. R., Young, G. J., Loomer, L., & Madison, K. (2018). State-level community benefit regulation and non-profit hospitals’ provision of community benefits. Journal of Health Politics, Policy & Law, 43(2), 229–267. Retrieved from the Trident Online Library. Sohn, J. W., Kim, H., Park, S. B., Lee, S., Monroe, J. I., Malone, T. B., Kinsella, T., Yao, M., Kunos, C., Lo, S. S., Shenk, R., & Machtay, M. (2020). Clinical Study of Using Biometrics to Identify Patient and Procedure. Frontiers in oncology, 10, 586232. https://doi.org/10.3389/fonc.2020.586232 Song, Z. (2014). Accountable Care Organizations in the U.S. Health Care System. J Clin Outcomes Manag. 2014 Aug 1; 21(8): 364–371. Texas Department of State Health and Human Services. (2022). Childhood and Adolescent Cancer Classification. Retrieved from https://www.dshs.texas.gov/tcr/data/childhood.aspx Txtdc.org. (2022). Texas Diversity Council. Retrieved from Texas Diversity Council (txdc.org) USA.gov. (2019). Improved Diagnostics & Patient Outcomes. https://www.healthit.gov/topic/health-it-and-health-information-exchangebasics/improved-diagnostics-patient-outcomes U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool. (2021). Based on 2020 submission data (1999-2018): U.S. Department of Health and Human 40 Services, Centers for Disease Control and Prevention and National Cancer Institute; https://www.cdc.gov/cancer/dataviz. Womble and Dickinson. (2022). Seven Elements of an Effective Compliance Program. Retrieved from https://www.womblebonddickinson.com/us/insights/articles-and-briefings/sevenelements-effective-compliance-program Trident University Samantha Daniel MHA598 Capstone March 2022 Dr. Syneatha Sewell HEALTHCARE DELIVERY & MODELS Patient Directory Electronic Health Record (EHR) ENGAGING HEALTH Mobile Tools for Better Communication Factime Telehealth Appontments Electronic Health Record Medhost Security Measures Impermissible Use INFORMATION SYSTEMS ORGANIZATIONAL PROCESS MAP ORGANIZATIONAL PROCESS MAP CONTINUED OPERATIONAL EXCELLENCE SCALE & TOOLS SIX DOMAINS OF HEALTHCARE QUALITY Safe Effective PatientCentered Timely Efficient Equitable •Avoiding harm to patients by proving care in that is supposed to help •Services provided are of benefit to the patient and avoid underuse or misuse of treatment •Responsive and respectful care that addresses all the needs of the patient to include their values and personal preference •Reducing wait times for appointments by enabling access to care and avoid harmful delays to patient care •Avoid fraud, waste, and abuse to include equipment, energy, time, and supply •Quality of care that does not vary due to personal bias such as with gender, ethnicity, socioeconomic status, and ethnicity Quality Healthcare CONCLUSION AND RECOMMENDATIONS PeopleTraining Data Software Hardware Process REFERENCES Agency for Healthcare Research and Quality. (n.d.). Six domains of health care quality. Retrieved from https://www.ahrq.gov/talkingquality/measures/six-domains.html Anand Narasimhan, H. H. (n.d.). Organizational design: Inviting the outside in. Retrieved from IMD Corporate Learning Network: https://www.imd.org/research-knowledge/articles/organizational-design-inviting-theoutside-in/ Bauer, G. (2018). Delivering value-based care with e-health services. ACHE. Retrieved from https://www.ache.org//media/ache/aboutache/covid/hap/deliveringvaluebasedcarewithehealthservices5.pdf Bersnick, J., (2017). Which Healthcare Data is Important for Population Health Management? Retrieved from https://healthitanalytics.com/news/which-healthcare-data-is-important-for-population-health-management Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2002). Cultural competence in health care: Emerging frameworks and practical approaches. New York, NY: The Commonwealth Fund. https://hpi.georgetown.edu/agingsociety/pubhtml/cultural/cultural.html REFERENCES Bloom, J. R., Alexander, J. A., Lerman, S., & Norrish, B. (1994). Institutional and environmental influences on staffing strategies. Dallas, TX: Academy of Management. Brooks, P., & Avera, H. (2010). Standards and interoperability in healthcare information systems: Current status, problems, and research issues. In Fifth MWAIS Conference. City-data.com. (2022). Welcome to City-data. Retrieved from http://www.city-data.com/ Clarke, J., Bourn, S., Skoufalos, A., Beck, E.H., & Castillo, D.J. (2017). An innovative approach to health care delivery for patients with chronic conditions. Population Health Management, 20(1):23–30. doi:10.1089/pop.2016.0076. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278805/#__ffn_sectitle Colla, C. H., & Lewis, V. (2016). Hospitals Participating in Accountable Care Organizations Tend to Be Large and Urban, Allowing Access to Capital and Data. Improving Health Care Quality. REFERENCES Glandon, G. L., Smaltz, D., & Slovensky, D. (2013). Information Systems for Healthcare Management (8 ed.). Americal College of Healthcare Executives. Health Network Community Health Needs Assessment. (2020). Tarrant County Hospital District/JPS. Retrieved from https://safe.menlosecurity.com/doc/docview/viewer/docN67A799D84BBDe00ba0926bd93e08f4b428d998d5f6b4155eab3 efa049fd4771f296f6807147d Handbook of Clinical Neurology. (2015). Chapter 4 - Neurofibromatosis type 1 and Chapter 5 - Neurofibromatosis type 2. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/B9780444627025000044 Karimia, F. (2015). Clinical information systems end-user satisfaction: The expectations and needs congruencies effects. Journal of Biomedical Informatics, 53:342–354. Retrieved from: http://www.sciencedirect.com/science/article/pii/S1532046414002731 Lakshmi, N., Adetayo, A., (2019) Cultural Competence and Ethnic Diversity in Healthcare. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571328/ REFERENCES McLaughlin, D. B., & Olson, J. R. (2017). Chapter 15: Holding gains. Healthcare Operations Management. Chicago: Health Administration Press. Murphy, S. P., Peisert, K. C., & Murphy, C. J. (2015). Board organization and structure. The Governance Institute. Retrieved from https://nrchealth.com/wp-content/uploads/2017/05/Board-Organization- Structure_AnIntentional-Governance-Guide_Patrick-M....pdf National Institute of Neurological Disorders and Stroke. (2022). Neurofibromatosis Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurofibromatosis-Fact-Sheet Roboam, A. R., Orlando, S., Marcos, F., & Sanchez, G. M. (2019). Electronic Health Record implementation: A review of resources and tools. Cureus, 11(9). Retrieved from https://www.cureus.com/articles/21899-electronic-healthrecord-implementation-a-review-of-resources-and-tools Song, Z. (2014). Accountable Care Organizations in the U.S. Health Care System. J Clin Outcomes Manag. 2014 Aug 1; 21(8): 364–371. REFERENCES Texas Department of State Health and Human Services. (2022). Childhood and Adolescent Cancer Classification. Retrieved from https://www.dshs.texas.gov/tcr/data/childhood.aspx Txtdc.org. (2022). Texas Diversity Council. Retrieved from Texas Diversity Council (txdc.org) USA.gov. (2019). Improved Diagnostics & Patient Outcomes. https://www.healthit.gov/topic/health-it-andhealth-information-exchange-basics/improved-diagnostics-patient-outcomes
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Trident University

Samantha Daniel
MHA598 Capstone
March 2022
Dr. Syneatha Sewell

❑ NCMC

as a non-profit
organization will fall under
an Accountable Care
Organization

❑ Its

main role is to help in
child preventive and
treatment care.

 The

E-health in NCMC is
very important since it has
supported its operations.
operations are
mentioned below,
including how they affect
NCMC

Mobile Tools for
Patient Directory Better
Communication

 These

Factime
Electronic
Telehealth
Health
Record (EHR) Appontments

 With

the information
system, NCMC is able
to obtain better means
of providing security
and supporting its
needs and operations.

Electronic Health
Record
Medhost
Security Measures
Impermissible Use

 Operational

excellence tools NCMC uses
includes work teams, performance
management, and process excellence.

 These

tools and scales have helped NCMC
develop the best operational services.

OPERATIONAL EXCELLENCE
SCALE & TOOLS

 Six

sigma and lean are important in allowing
competence in NCMC because they complement
one another.

 Lean

eliminates waste

 Sigma

brings training value for patient care

SIX DOMAINS OF HEALTHCARE QUALITY
Safe
Effective
PatientCentered
Timely
Efficient
Equitable

•Avoiding harm to patients by proving care in
that is supposed to help

•Services provided are of benefit to the patient
and avoid underuse or misuse of treatment

•Responsive and respectful care that addresses
all the needs of the patient to include their
values and personal preference

•Reducing wait times for appointments by
enabling access to care and avoid harmful
delays to patient care

•Avoid fraud, waste, and abuse to include
equipment, energy, time, and supply

•Quality of care that does not vary due to
personal bias such as with gender, ethnicity,
socioeconomic status, and ethnicity

Quality
Healthcare



NCMC must provide a uniform standard of care
to maintain high quality services



It must also use all information available, which
will help ensure efficiency.



NCMC employees will not judge patients.



will ensure quality patient care according to
code of ethics.

CONCLUSION AND RECOMMENDATIONS
PeopleTraining

Data

Software

Hardware

Process

REFERENCES
Agency for Healthcare Research and Quality. (n.d.). Six domains of health care quality. Retrieved from
https://www.ahrq.gov/talkingquality/measures/six-domains.html
Anand Narasimhan, H. H. (n.d.). Organizational design: Inviting the outside in. Retrieved from IMD Corporate
Learning Network: https://www.imd.org/research-knowl...


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